Dex: Transforming Pediatric Tonsillectomy Outcomes

TOPLINE:

The administration of dexmedetomidine was associated with reduced perioperative requirements for opioids in pediatric tonsillectomy, along with lower likelihoods of emergence delirium and postoperative nausea and vomiting.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 16 randomized controlled trials involving 1634 pediatric patients (mean age range, 4-8.5 years) undergoing tonsillectomy with or without adenoidectomy under general anesthesia.
• Dexmedetomidine was administered intravenously during the procedure at doses ranging from 0.1 to 4.0 μg/kg alongside opioids compared with opioids alone.
• The primary outcome was perioperative requirements for opioids, measured in oral morphine equivalents.
• Secondary outcomes included incidences of perioperative respiratory adverse events (including severe or sustained cough), emergence delirium (determined using the Pediatric Anesthesia Emergence Delirium Scale), and postoperative nausea and vomiting.

TAKEAWAY:

• The administration of dexmedetomidine was associated with reduced perioperative requirements for opioids (mean difference, -0.25 mg/kg; 95% CI, -0.36 to -0.13), as analyzed from seven studies.
• The likelihood of emergence delirium was lower with the use of dexmedetomidine (risk ratio [RR], 0.24; 95% CI, 0.08-0.71), as analyzed from three trials.
• For every 0.5 μg/kg increase in the dose of dexmedetomidine, the RR for emergence delirium decreased by approximately 87%.
• The administration of dexmedetomidine was associated with a lower likelihood of postoperative nausea and vomiting or postoperative vomiting (RR, 0.48; 95% CI, 0.35-0.66; 12 trials).

IN PRACTICE:

“Dexmedetomidine may improve the perioperative course of children undergoing tonsillectomy, as moderate certainty evidence indicates that it decreases perioperative opioid requirements, and moderate certainty evidence suggests it reduces the rate of emergence delirium, with dose-dependent effects, when compared with control,” the researchers of the study reported.

SOURCE:

The study was led by Julia M. Olsen, MD, of the Department of Anesthesia and Pain Medicine at The Hospital for Sick Children in Toronto, Ontario, Canada. It was published online on July 11, 2025, in the Canadian Journal of Anesthesia.

LIMITATIONS:

The publication bias could not be assessed due to a limited number of trials. The certainty of evidence was affected by significant heterogeneity in the primary outcome. Subgroup analysis could not be performed due to lack of data, and the small sample size and zero event rates for some outcomes in many trials hindered mediation analyses.

DISCLOSURES:

This study did not receive any specific funding. No conflicts of interest were declared.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.